ACFI Love it! Hate it!

Transcription

1 ACFI Love it! Hate it! Presenter: Leigh Welling Ph September 2017

2 ACFI a Quick Overview 12 Questions plus 2 Diagnoses Essentially assessment based Checklists (ticks in a box) of care delivered results in an A, B, C or D rating in each question. All care documentation must support claim e.g. care plans and progress notes Based on usual, predictable and high frequency care needs Three Domains determine the subsidy funding

3 Three Domains: Activities of Daily Living Nutrition, Mobility, Personal Hygiene, Toileting and Continence. Behaviour Supplement Cognitive Skills, Wandering, Verbal, Physical, and Depression Complex Health Care Supplement Medication and Complex Health Care Procedures.

4 Scoring ACFI QUESTIONS A B C D Category Points 1 Nutrition High Mobility Medium Hygiene Low Toileting Continence

5 ACFI Subsidy Rates ADL s Behaviours Complex H.C. HIGH $ $36.19 $67.32 MEDIUM $79.80 $17.36 $46.62 LOW $36.65 $8.37 $16.37 NIL $0.00 $0.00 $0.00

6 Optimising ACFI Claims Made easy!!!

7 Optimising ACFI Two Key elements being; Admission Policy High ACFI average funding = High dependency residents. Skilled ACFI staff knowing all the ethical ACFI tricks and constantly reviewing residents for increased care needs. Upskilling staff through ACFI Workshops and Consultants (of course!!)

8 Optimising AFI claims Develop a system that works for your facility. Share the gathering of data for ACFI to all care and activity staff. General staff education on the elements of the care they deliver to residents that contributes to ACFI Gently educate the attending medical practitioners in how valuable their contribution is to ACFI claims. Make the best use of Medibank documentation. Plan ahead so that ACFI s are not rushed at the last moment.

9 Optimising AFI claims Someone appointed to take overall responsibility for ACFI claims. In larger facilities this is generally not the Director of Care. This person does not necessarily have to be a RN. Do we appoint a ACFI champion??? There are advantages and disadvantages. Skilled support team is best. Appointee needs sufficient allocation of hours to fulfill role.

10 Why has ACFI changed in 2017? The government s Mid-Year Economic Review stated that ACFI subsidy funding is higher than Treasury forecasted, especially the CHC Domain Many changes to the scoring in the Complex Health Care Domain. Extend the recovery of overpayments from inaccurate claims from the former six months back to the date of submission.

11 Some Changed Rules Government plans to reduce funding to aged care by $1.2 Billion over the next four years. Department can direct a facility to lodge a new ACFI when they suspect a significant drop in a resident s care needs.

12 More Changed Rules At validation where there are 2 or more downgrades with significant changes a facility can be placed on a 2 year warning period. Fines ($10,800 per offence) will be imposed if further validation downgrades occur in the warning period. Accurate ACFI claims and complete ACFI Appraisal Packs are essential!!

13 Rule changes Increased validations to target areas of risk for inaccurate claiming. A new $10 million computer to help! Regular on-site and desk audit validations will continue. The department is delivering webinar workshops aimed at education to enhance the accuracy of ACFI claims. Fees for ACFI appeals but reimbursed if claim upheld.

14 ACFI Compliance - Webinar False claims referred to the Australian Federal Police for consideration. Repeat ACFI review visits to providers within weeks if a very high incidence of misclaiming is discovered.

15 No Indexation in 2017/8 Indexation of ACFI rates will not increase in the financial year. $ will remain top dollar for a resident claimed as HHH through to June 30 th The Complex Health Domain will only be indexed at 50% of the increase granted in the financial year.

16 Future Direction of ACFI Wollongong University commissioned by government to develop future options for aged care funding. Objectives to include equitable stable long term funding, recognising basic costs to provide a service to any resident. Current ACFI is inefficient, duplicitous and subject to gaming!

17 Future Direction of ACFI Option One: Refinement of current ACFI deleting rarely claimed care items, moving Cognition and Depression out of the Behaviour domain. Lead time to implement 6 to 12 months. Option Two: ACAT s allocate to one of four funding bands. ACAT s to be recalled if care needs change or increase. Lead time 6 to 12 months.

18 Future Direction of ACFI Option Three: Similar to option two but with supplements for special needs. Supplements to be approved by an external assessor. Lead time to start 12 months. Option Four: Activity Based Funding with branch like care claims. Lead time to start 2 years.

19 Future direction of ACFI Option Five: (preferred) Fixed base price per resident per day. Plus variables to be determined by an external assessor. Variables like chronic wound or Palliation and to be time limited. One-off admission payment covering initial costs. External assessors could be retrained ACAT s, new agency or accredited staff to assess needs in other facilities, not their own. Lead time 2 to 3 yrs + interim Opt.1

20 Preparing for an ACFI audit

21 ACFI Validations Generally 20% of approved beds will be reviewed. Audits historically do not go back further than claims lodged six months before the visit. Though with the changes to ACFI it is now common for some reviews to go back to The bulk of files audited will have been lodged six to eight weeks before the visit. Desk audits are being conducted too.

22 ACFI Validations Files of deceased residents have not been routinely reviewed. Validators are entitled to be introduced to the residents they are reviewing and will stay and observe care delivered. Validators are clarifying ACFI questions by interviewing staff.

23 ACFI Validations When notified of an impending ACFI audit take the time to review the contents of all ACFI Appraisal Packs in the target range of time. To ensure the contents are complete and match the claim submitted. On the day of the audit have a suitable staff member act as a gofer to gather any additional evidence required.

24 ACFI Validations Choose with utmost care staff who may be asked questions relating to the care of the residents. Care staff are prone to minimise or not recognise care given. Remember the word independent is a four-letter-word and best never used within a facility!!!

25 ACFI Appraisal Packs Get the packs right!! Consistent order of content Currently, more is better! Fat packs means more reading time and less time to walk around asking questions!! Ensure all documents are correctly signed off and dated within 6 months of lodgment.

26 Free ACFI Updates Advanced ACFI information available at no cost or obligation found at: Newsletters What s New Updated monthly. Leigh - Ph

27 PAIN MANAGEMENT IN AGED CARE Everybody wins! Presenter: Leigh Welling Leigh Welling and Associates

28 Pain Management Claimed in the 3 rd Domain Complex Health Care. Three programs: 12.3 Massage or Heat Packs 12.4A Massage or Technical Equipment undertaken by an RN or Allied Health Professional (AHP) 12.4B as per 12.4A but only by an AHP

29 Pain Management Foundation requirements include: Resident must have pain supporting diagnosis. Resident on regular analgesics helps! Pain assessment identifies pain. Resident agrees to treatment. Treatment plan must be ongoing

30 Pain Management 12.3 Heat packs/massage can be delivered by any staff member. Must achieve 20 minutes staff time each week. Must be delivered at least weekly. Gathers just one (1) point in ACFI Question 12.

31 Pain Management 12.4A Massage or Technical equipment designed especially for pain management. Can be undertaken by an Registered Nurse or a Physiotherapist, Occupational Therapist, Osteopath or Chiropractor. Must achieve 20 minutes staff time each week and be delivered minimally weekly. Gathers three (3) points in Question 12.

32 Pain Management 12.4B Pain Management requirements:- 4 DAYS & 80 minutes 1:1 staff treatment time weekly. Can only be undertaken by a Physiotherapist, Occupational Therapist, Osteopath or Chiropractor. Cannot be delivered by a Therapy Aid or an Exercise Physiologist or any Nurse. Gathers Six (6) points for Question 12.

33 Pain Management ACFI Question 12 is all about points. 1 to 4 points = B 5 to 9 points = C 10 points plus = D ACFI 11 Medication and ACFI 12 work together as a matrix. All residents will achieve a B in Q11 Medication.

34 Pain Management Combinations and funding in Complex Health Care Domain. Q11 B + Q12 A = LOW = $16.37/day Q11 B + Q12 B = LOW = $16.37/day Q11 B + Q12 C = MEDIUM = $46.62/day Q11 B + Q12 D = HIGH = $67.32/day Scenarios

35 Pain Management Economics of Pain Management Programs (PMP s)!! Combinations with other claimable Q12 items works well. E.g Change of Position (3 points) A (3 points) = MEDIUM $46.62/day. Cost to deliver PMP is $25.00 per week. The 12.4A delivers a gross increase of $ less $25.00, a nett benefit of $ per week.

36 Pain Management More economics. A resident gets 12.5 Change of position (3 points) B (6 points) (1 point) So 11B Meds + 12D = $67.32/day. Care staff deliver heat pack. Physio 12.4B. Without Physio PMP only $16.37/day so an increase of $50.95/day. $50.95X 7 = $ less cost of Physio service $100 a nett increase of $ per week.

37 Pain Management In all combinations a Physio 12.4B Pain program self funds and delivers a nett benefit to the facility. So everybody wins! The resident gets heaps of 1:1 pain management, the facility always has a positive $ balance income over costs. And a young Physio is employed!!!